The Anatomy of a Goodbye

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2015-08-06-1438895802-5386334-AlexLickermanbook.jpgMy friend's dad died in February. As the months went by I wondered if his research on resilience had helped. Alex Lickerman is a doctor in Chicago and the author of The Undefeated Mind: On the Science of Constructing an Indestructible Self. I waited what I thought was an acceptable time before I invited him to join me on Doing What Works. He happily agreed. You can listen to the interview if you want. Here are some highlights...

How are you doing, Alex?

I'm okay. My dad had been sick for a while. He had a severe case of Parkinson's -- dementia -- and he hadn't been himself for the past year. I'd been grieving for a long time. I felt like I'd lost him long before he died.

Dementia is subtle. It peels away someone layer by layer, almost like watching grass die. It's difficult to know when he stopped being the dad I knew, but there came a time when he definitely did. And eventually you stop hoping he'll live and start waiting for him to die because he's miserable and we're miserable watching him be miserable.

What do you guess he would've said about that choice, not that he had one?

It's a fascinating question. I vividly remember a conversation with him when I was in medical school. He said, "If I ever stopped being able to function, would you help me end things?" He didn't want to live in a nursing home. He was afraid of them. I told him I'd do anything to keep him from suffering but I added I wouldn't even know how to begin to contemplate something like that. I just filed the request under "someday."

When he got really sick he surprised all of us by saying he didn't want a DNR ("do not resuscitate") order. I'm convinced if the person he was could've looked down on the bed at the person he became he would've said, "Put this man out of his misery." But when he got there he felt very differently. I don't know if that was because of the dementia or because of a well-known psychological truism, which is that we're all pretty lousy at predicting how we'll respond emotionally to future events. I wrestled with those contradictory wishes, those of the man who was in front of me -- whose mind wasn't all there -- and those of the person he used to be, who hadn't experienced the last year.

I still don't have the answer to that, by the way.

Were you with your dad when he died?

I found him. He'd stopped eating and drinking, one reason we knew he was going to die soon. I'd been visiting him pretty much daily at this point. He looked like he was asleep. I looked more carefully and realized he wasn't moving at all. I thought, "Oh my goodness. This is it." I walked over to him and I shook him and he had that passive, waxy sort of immobility I'd seen in people when I'd pronounced them dead. I realized he was gone and it was strange what overcame me. You want to make absolutely sure. So I listened to his heart and I waited for breathing, and it became clear he had died.

I found one of the nurses and I said, "I think my father's just died."

The first thing I felt was shock he was really gone. This was someone I'd been around my entire life. I couldn't imagine him not being here. He and I had had many, many talks about dying. We were both that type of philosophical person. It was shocking to realize his story was over. I didn't quite know what to do with myself.

I went to the nurse's station and called my mom and my brother. Then I went back to his room and started crying. I just sat there with him a little while and thought some things and said some things. Then I walked out of the room. Then I went back in and cried some more. Then my mother and brother came and they broke down and started crying when they saw for themselves he was dead, and we just sort of stood there and cried together.

The manager of the nursing home came in to express her condolences and I had a very strange reaction to her. She was very gentle and kind but as she talked I found myself wanting her to leave. I didn't want her to be there. I almost told her I'd rather be with my dad by myself for a little while. She was really well-meaning and she was saying all the right things, but what I wanted was solitude.

I'd been in her position many times. I'd become comfortable with the notion that when someone dies there's nothing you can say to make it better. That's not the goal. What I realize now is what you need to do is ask people what they want right now: "What can I do? Do you want to be alone? Do you want me to stay with you? Would you like some water?"

I'm sure if she would've asked what I wanted I would've told her, but she didn't ask so she didn't know.

Does anything help with grief?

Yes. There's something profound that helps, and that's acceptance. Accepting what you can't change, accepting there are things you don't know and can't know and will never know -- that's very freeing. My dad's death did nothing to change my beliefs about that.

As to the stages of grief so many of us have heard about, they don't necessarily appear in a certain order and there's no guarantee you'll end up at acceptance. I didn't go through any of them. I got to acceptance right away. I was aware that I didn't want to be incapacitated by my grief for very long -- not that I'm in control of it -- but there was a sense of being determined to figure out how to detach and move on. I think there's magic in deciding you will. Not that you won't relapse. I'm mostly okay but I can get into a mood where I'm not okay. The first Father's Day [which was the day after this interview] is going to be tough. I can get a little weepy thinking about that, and even talking with you about it makes me sad.

But I started grieving about a year before my dad died and I had a chance to get used to it. Feelings have a certain lifespan. Even if you wanted to cling to sadness you can't. We habituate to even that. Studies show elderly people who lose their spouses are back to their previous level of functioning and mood within about a year and a half.

Is there something you did that made things easier?

Yes. The most important thing all but one of us did was get clear with my dad, so by the time he died there was nothing left unsaid and no unresolved issues between us. When I let him go in my heart I let him go without any regrets.

It's a big cliché but boy, is it true. When you see death coming get right with your loved ones because you will not get another chance. When I talk with people whose grief never entirely abates it's because there was unfinished business that stayed that way.

Is the willingness to be sad for as long as you need to the key to healing?

That's it. No question. People cause themselves far more suffering when they try to avoid legitimate pain. You can't run from it. It might appear you can, temporarily, but that's an illusion.

I let myself be sad. I let myself cry. Over time the grief has been abating.

People hate to feel bad. I get that. But if there's one message I'd like to get across from this conversation it's that whatever you're feeling, whether it's sadness or anger or guilt or any other really unpleasant emotion, let yourself feel it. There's no way to get rid of it besides going through it.

Thanks for sharing your story, Alex.

I appreciate the opportunity. It might sound strange to say, but I really enjoyed it.